Provider Demographics
NPI:1639637325
Name:DUNN, LAURA FAYE (RN CADC1)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:FAYE
Last Name:DUNN
Suffix:
Gender:F
Credentials:RN CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5316
Mailing Address - Country:US
Mailing Address - Phone:503-901-4203
Mailing Address - Fax:
Practice Address - Street 1:1122 NE 122ND AVE STE A102
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2082
Practice Address - Country:US
Practice Address - Phone:503-901-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200341401RN163W00000X
OR17-11-04101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse